Operation Ultrasound

Holly and I watched a moving piece on public television a few weeks ago that documented the lives of military families. The program examined how these families cope with the stress of separation and the ubiquitous fear of the unknown. It left us feeling indebted and obligated to the people who risk their lives to preserve an esoteric right for the rest of us to live ours the way we choose. We wanted to give something back, and as valuable as a care pack full of chocolate is in Kabul, we wanted to offer something that could genuinely help some of these young families to stay connected. Starting May 1st we are launching "Operation Ultrasound", a FREE service to pregnant wives of deployed US servicemen. Participants will get a CD with a digital image file of their baby that they can email to their husband oversees. Recent studies have shown that the bonding experience provided by a 3D ultrasound can help mothers improve their diets and exercise more frequently, but for military fathers, the chance to actually see the baby and create a pre-birth bond is instrumental in drawing the whole family closer together, and it can provide an important bridge connecting dad back home. Holly figured she would do something she knows, and she knows ultrasound. If you guy's know of a local military family that could use this service, feel free to pass them our way. You can see the official press release here, and there is more information about it on our website. Help us get the word out, we tentatively set this to run through June, but if the response is there and it's not overwhelming for us, we're open to extending it as long as we need to.

Staging the New Bathroom

My to do list continues to grow at an alarming pace. I worry that I may never be able to complete all of the remodeling jobs that have made it onto the short list. I began to prioritize them last week and it has become overwhelming to say the least. What ends up happening is that I have to place business related projects on the top of the list, but in an inevitable catch-22, we can't shut down operations long enough to complete them. One of the projects on the top of the list is the lab bathroom. It must be remodeled for handicap accessibility. This is a total overhaul that includes busting up concrete to relocate waste pipes. This isn't an overnighter. I have decided that the easiest way to handle such a project is to plan it to the letter, pre-purchase all of the required material, and stage-assemble everything for fit in a mocked up work area prior to removing a single nail in the existing bathroom. I have learned from experience that what drags a project into do-it-yourself purgatory is being unprepared for the unexpected. Having to run back and forth to the hardware store for the correct plumbing fitting two or three times adds hours to the effort. Staging can eliminate a great deal of this. When I built our kitchen island, I staged it in the living room; placing painters tape on the floor to locate walls and pipes. When I moved the finished product into the new space, it was completed inside of an hour. All I had to do was tack down the shoe molding. I plan to take the same approach with the lab bathroom. As such, I have staged everything in the living room again. I have ordered everything except for the doors, which I manged to find at Maner supply on Cross County Road. I needed ADA compliant solid core prehung doors, not cheap...and not light either. They have metal frames and weigh at least a hundred pounds. I'm picking them up this afternoon. Staging has already paid off, I found that my kids had left the lid off of the plumbers putty, allowing it to harden. If I had been in the middle of the remodel, I would have had to stop to make a trip to the store. The diagram to the left shows the new layout.

I aint afraid of no monsters

glumbert.com - 3-year-old trash-talks monsters

Ignorance is bliss

Every once in a while those uncertain actions we take on a hunch are validated by a successful outcome. As small business owners, my wife and I make a lot of decisions from the gut. You have to. Market analysis is about 95% common sense and about 5% hunch. Several years ago when my wife started her elective ultrasound center, we did a full scale market analysis. We researched the total available market utilizing US Census data for our regional population and combined it with data pulled from South Carolina's Department of Health and Environmental Control on birth rates in our area. We divided the total available market into income level categories and analyzed the resulting cross sections. Through statistical inference we were able to quantify our projected target market. The numbers didn't lie. We knew going in that we would have to reach an abnormally high percentage of the target market in order to generate enough cash flow to remain solvent, but since there was no competition in the area, we decided to go ahead and take a leap of faith. Months into the ordeal and very near throwing in the proverbial towel, we realized that Dionysus had slain Apollo and the ensuing exuberance outweighed the rational. We ended up making significant changes to our business model out of necessity, but we emerged stronger and wiser in the end. We still offer elective 3D ultrasound, after all, being able to offer this incredible experience to women in the Lowcountry was the impetus for the business in the first place, and that hasn't changed. We spent a tremendous amount of time and energy to convert from an elective, self pay approach to a physician ordered reimbursable approach. It has already proven to be the best decision we have made to date. Last week while I was doing some research on the Internet I noticed that the owner of a well established elective 3D ultrasound center in the midlands had placed her business on the market for sale, effectively validating our hunch that an abnormally high percentage of the market is required to support these endeavors. I won't claim to know the underling reasons behind that sale, but based on her publicly disclosed financials, I'd say it was because it barely pays the rent. Been there done that. Like I said, market analysis isn't rocket science, it's common sense. Unlike other service oriented businesses, the market for elective ultrasound is finite, meaning, you can't manufacture clients --without an army of irresponsible gigolos. To be in the market for a novel 3D ultrasound, you have to be a female, be between eighteen and twenty-six weeks pregnant, and have at least some degree of disposable income. If that's not a finite market I don't know what is. A few months ago while our business was already undergoing its transformation, we received a phone call from a potential competitor who stated that they intended to open an elective 3D ultrasound center in our market. To be fair, they were returning a anonymous call we had placed to inquire about their pricing structure and service offerings. They just wanted us to know that they thought there was enough business out there for everyone, and wanted us to think of them as a partner as opposed to a competitor. Holly and I both got a good chuckle out of that...but under the circumstances, perhaps a belly laugh would have been more appropriate.

Latest from Hollyweird

Apparently yet another 'celebrity' has proven without a shadow of doubt that the land of glam is truly out of touch with reality. Listen to Alec Baldwin's absolutely disturbing rant left on his eleven year old daughter's voice mail. I think they will be postponing that family vacation to the Neverland ranch this year. Unbelievable. I never liked the Baldwins anyway, now I have a legitimate reason to despise at least one of them.

Late Freeze Spoils SC Peach Crop

The unexpected Easter freeze seems to have devastated the palmetto states peach crop, a reported 35 million dollar annual production and the second largest peach crop in the nation. California is the first. I feel for the upstate farmers. An April freeze attacks bud growth, usually spelling disaster for their fruit. I live a block away from the farmers market in Summerville, and I frequent the market every Saturday morning with my kids. The opening of the market in April marks the perennial start of the growing season, and its close in October wraps up the local harvest with the traditional bounty of fall; squash, pumpkins, and corn. In the summer though, fresh Carolina peaches are always a favorite with my family. I'm convinced that my youngest can devour half her body weight in peaches. I may have to boycott those California Peaches this year, they're just not the same as stone fruit from the upstate. Although they vary from growing season to growing season, I find the western varieties not so appealing in the taste department, arguably the most important characteristic for fruit of any kind if you ask me. The California ones are clearly beautiful specimens to behold, but I'll take a dent or two for a Carolina peach bursting with flavor and aroma any day. Fruit is not unlike honey in that it takes on a subtle flavor distinction from its indigenous surroundings, and because this is obviously Gods country, our crops taste, well...divine. I can only pray that our berries held out, what kind of summer would it be without fresh local berries?

Moving up, Moving out

I realize that this blog was originally conceived to chronicle the restoration of a charming downtown Summerville cottage, but restoring a 100+ year old home is only one of my many duties. I have a large hat collection. Monday to Friday I wear a business systems analyst fedora for a defense contractor supporting the Space and Naval Warfare Systems Center over on the old Naval Weapons Station. In the evenings I don the IT guy derby for my wife’s diagnostic imaging center. I keep the VPN firewall up and running and make sure that the radiology and DICOM files are being processed and archived as planned. Maintaining the PACS system should be a full time job, but I squeeze it into a few hours in the evenings. On weekends and most holidays, I put the hardhat on and work on the house.

As I described in a previous post, we purchased the property primarily as a mixed use residential-professional office arrangement. We intended to convert a large detached two car garage into a home base for our mobile diagnostic ultrasound service, and that is precisely what we did. I completely renovated that outbuilding, wired it, installed a bathroom, installed central heat and air, and built out the area as office space, but as our business grew, we grew out of the building and ended up moving our offices into our residence and redesigning the converted garage to function as an outpatient exam room for vascular and prenatal ultrasound.

The CMS (Medicare) test deposit was entered into our bank account on Thursday, so it would appear that our enrollment package is nearly complete. We will be able to accept insurance any day now. Our promotional material has arrived and we will begin a comprehensive marketing campaign within the next two weeks. What that means is that our business is growing. We will soon need even more space. After many hours of contentious deliberation, Holly and I decided that we would inevitably have to convert the entire residence into an outpatient imaging center. With some work, the building would make an ideal medical practice. After all, a local attorney operated out of the space for many years. So, essentially the front two bedrooms will be converted into exam rooms, and the parlor will be converted into a waiting room. The living room will house a horseshoe administrative area, and the back bedroom will be an executive office. The kitchen, of course will become the employee break room. The converted office outside will become a vascular lab.

In order to make this space work as a state of the art imaging center, we have to take on several large projects including building a wheelchair ramp off of the front porch. We also have to remove the gorgeous claw foot tubs and replace them with urinals and ADA compliant fixtures. We have to build the horseshoe administrative area, run the appropriate communication lines, and put sinks in all of the exam room spaces. Most of the doors will have to be widened and replaced with industrial solid core flush units. We would have to replace all of the carpeting, and install vinyl composite tile in the exam rooms. We also would need to replace the windows and cover them with attractive Bermuda shutters on the exterior to limit the sunlight infiltration and create the appropriate ultrasound conditions. Of course, I will probably hire a general contractor to tackle these projects. All in all, the layout couldn't be better, and the great part is that in the end we can deed the property over to the LLC and instantly increase the asset side of the balance sheet.

A couple of weeks ago I noticed that our facility was chastised as “make-shift” on another merchant’s blog. I don’t know what this persons motivation was or even if they have ever been inside our facility. I doubt that they know the reasons behind our conscious and socially responsible decision to utilize a mixed use zone. I doubt that they know that most of the homes on our street, with the exception of one, are currently in use as professional offices. In fact, I doubt that this person knows much of anything. I have lived in Summerville my entire life with the exception of a few years while I was away in college. I was born in the old hospital, now the county services building off of Main Street. When I was in high school the US Census count said there were less than six thousand residence in Summerville. There are nearly fifty thousand now, with over half of them arriving in the last decade alone. With all these new residents comes new services, new shopping centers, and new strip malls. If there is one thing I despise more than anything else, It's seeing new strip malls detracting from our truly remarkable landscape. Don’t get me wrong, as a small business owner; I’m clearly not against growth. I just think it’s a shame to build new strip malls when so many existing ones are so anemically vacant.

In order to maintain the integrity of the town center, people need to live where they work. Otherwise you don’t have heterogeneous sustainable growth, you have sprawl. No one wants sprawl. Anyway, a note to the uninformed: Our decision to live and work from our home was not based on financial reasons, or any other reason that you might dream up for that matter, rather it was based on a humble attempt to revitalize a part of our beloved community; a community that is being threatened by the very irresponsible development you operate your own business from. Get a life. Get informed before you feel the need to comment on something you obviously know nothing about.

Thoughts on Ultrasound

With South Carolinas' proposed ultrasound bill making headlines nationally, I thought I’d chime in on the business of ultrasounds in general...while the subject was still at arms reach. I feel uniquely qualified to comment on ultrasound since my better half operates an independent diagnostic testing facility, or IDTF, specializing specifically in the modality. Her facility offers both full diagnostics as well as 3D/4D limited diagnostic/elective ultrasounds.

Elective keepsake ultrasound facilities started appearing around the country in the late 1990’s, when ultrasound technology made the leap from grainy single-slice two dimensional renderings to volumetric three dimensional images that generated incredibly life-like images of babies in utero. We’ve all seen the commercials. These keepsake ultrasound places use the new 3D and 4D technology to provide expecting parents an exciting preview of their baby with detailed graphic image quality and motion.

My wife is an ARDMS registered sonographer and registered vascular technologist(RVT). She chaired the Diagnostic Medical Sonography program at our local community college, first as its clinical coordinator and then as the Program Director. She started the 3D-4D elective center three years ago. I wont hesitate to say that perhaps we viewed the world with rose colored glasses back then. The endeavor nearly broke us. The whole starting a business thing was exhaustingly hard work, and needless to say, although it has been what one would consider successful, it did not go as well as we had imagined it would in the sense that it failed to produce that elusive sense of fulfillment often associated with an entrepreneurial spirit. If you're a professional in the medical community in the Holy City you know that the community itself is holier than thou...both tight-knit and conservative by nature. So, for every minute of positive publicity she managed to generate, it was equally matched with two minutes of the negative variety. She only saw a handful of clients her first month despite aggressive advertising and a costly professional marketing campaign. She had essentially been black-listed by the establishment.

She started this business out of sheer passion and a love for the profession, and by stripping away the bureaucracy that has become ubiquitous in our health care delivery system, she could allow women access to the latest applications and technology while still maintaining a small, patient-focused atmosphere. After all, these services wouldn’t be available if there wasn’t a demand for them, and 3D ultrasound is truly a patient driven service. 2D ultrasound on the other hand, when operated by qualified sonographers is quite sufficient for obtaining clinical indications. Interestingly enough, very few CPT codes exist for 3D procedures, which means that reimbursements are the same for 2D as they are for its more desirable 3D cousin (desirable from the parent’s perspective that is).

So, for the short term at least, these entertainment businesses will thrive, and as well they should…because there is a demand, right? Not so fast. After three agonizing years in the elective ultrasound business, all the while kicking and scratching to preserve what was left of her professional image while fighting for every client, the handwriting was quietly etched on the wall. It is only a matter of time before the elective ultrasound industry is regulated completely out of business, but before that is allowed to happen, technology will catch up with it and drive the final nails into its coffin. I used this analogy with my son: "Why would you pre-order an x-box for $600 when you have a perfectly good play-station? You don't need the x-box, you simply want the x-box...and if you're patient, you can buy it next year for $350." The same holds true for these new ultrasound machines. Right now, Doctors don't need them, but as the technology advances, the new machines will become more affordable and rapidly replace the older units currently found in every OB-GYN office, thereby eliminating the demand for boutique ultrasounds altogether. In fact, there is convincing evidence that this trend has already began to manifest itself in the Lowcountry, and if you need further proof that self-refer is a tough row to hoe, take a look at what happened to Prevecare east of the Cooper a few years back.
My wife’s own company just purchased a brand new 3D ultrasound machine that is more portable, more powerful, and cost about half of what her first unit did…Now don’t get me wrong, it was still outrageously expensive, but my point is that they are now well within the reach of most private practices. Seeing that the handwriting was indeed on the proverbial wall, she felt it was time to start transitioning out of the elective ultrasound business and into the mainstream medical market. We needed to enroll in Medicare as a certified provider, begin accepting insurance, hire a physician, and contract with a radiology service to interpret the studies. She’ll still provide 3D ultrasound, it just means that we’ll be marketing to the doctors for referrals as opposed to marketing to the general public, but it also means an ADA approved facility, wider doors, wheelchair accessible ramps; grab rails, sinks in every exam room, the whole nine yards. More overhead? Absolutely. More regulatory oversight? Absolutely. Brighter future? Undoubtedly. One thing we will miss though is the 100% reimbursement we enjoy with the self refer work…a traditional provider only collects on about sixty percent of what is billed. Now I understand why they bitch so much.

So for all the moms-to-be out there seeking those keepsake ultrasounds...Do it the right way. Do it the safe way. Let your doctor know you want to have your diagnostic exam performed in a relaxing, patient focused environment, where the 3D pictures are complementary. He'll get a full report from our board certified in-state radiologist, we'll bill your insurance, and you can invite your family to share the experience. You'll leave with reassurance instead of a kitchen magnet and a false sense of security. We’ll keep you posted on the transformation.